Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983 (Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0001, 5-1-85 436-100-0002 Purpose of Rules The purpose of these rules is to establish requirements and procedures for offsetting permanent total disability benefits against social security disability benefits. Stat. Auth.: ORS 656.209 & 656.727 Stats. Implemented: ORS 656.209 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983 (Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered to 436-057-0004, 5-1-85; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16436-100-0003 Applicability of Rules (1) These rules are effective January 1, 2016, to carry out the provisions of ORS 656.209 and 656.727. (2) These rules apply to: (a) Those workers receiving awards for permanent total disability and eligible for and receiving federal social security disability benefits; and (b) Injured workers whose period of disability under the Social Security Administration began on or after June 1, 1965. (3) The director may waive procedural rules as justice requires, unless otherwise obligated by statute. Stat. Auth.: ORS 656.209 & 656.727 Stats. Implemented: ORS 656.209 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0003, 5-1-85; WCD 15-1997, f. 12-4-97, cert. ef. 1-1-98; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16436-100-0005 Definitions (1) “Authorization” means an order issued by the Workers’ Compensation Division directing the paying agent to offset the worker’s permanent total disability benefits by the amount specified in the order. (2) “Beneficiary” means an injured worker, and the spouse, child or dependent of a worker, who is entitled to receive payments under ORS 656.001 through 656.794. (3) “Department” means the Department of Consumer and Business Services. (4) “Director” means the director of the Department of Consumer and Business Services or the director’s designee. (5) “Division” means the Workers’ Compensation Division. (6) “Federal Disability Benefit Limitation” means the amount determined under 42 USC 224(a) and Social Security Administration rules. (7) “Offset” means a reduction of permanent total disability benefits based on the amount of federal social security disability benefits received by a worker. (8) “Paying agency” or “paying agent” means the self-insured employer or insurer paying benefits to the worker or beneficiaries. (9) “Performance Section” means the Performance Section of the Workers’ Compensation Division. (10) “Permanent total disability benefits” means compensation to an injured worker awarded permanent total disability compensation under ORS 656.206. (11) “Worker” means any worker receiving permanent total disability benefits. Stat. Auth.: ORS 656.726 Stats. Implemented: ORS 656.209 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin). f. & ef. 2-22-84; Renumbered from 436-057-0005, 5-1-85; WCD 15-1997, f. 12-4-97, cert. ef. 1-1-98; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16436-100-0006 Administration of Rules In administration of these rules, orders of the Workers’ Compensation Division are deemed orders of the director. Stat. Auth.: ORS 656.726 Stats. Implemented: ORS 656.209 & 656.726 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0007, 5-1-85; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16436-100-0008 Administrative Review (1) Any worker aggrieved by any offset authorization of the division may apply to the Workers’ Compensation Division for a reconsideration of that authorization before requesting a hearing. (2) Any party aggrieved may request a hearing under ORS 656.283. Stat. Auth.: ORS 656.726 & 656.727 Stats. Implemented: ORS 656.209 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0998, 5-1-85; WCD 15-1997, f. 12-4-97, cert. ef. 1-1-98; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16436-100-0010 Criteria for Eligibility (1) Permanent total disability benefits must be offset by the workers’ social security disability benefits. However, the total combined benefit, permanent total disability benefits plus social security disability benefits, must not be offset to an amount less than the greater of: (a) The amount the worker would have received under ORS chapter 656; or (b) The Federal Disability Benefit Limitation. (2) Permanent total disability benefits must not be paid by the paying agent in an amount greater than authorized by ORS Chapter 656. (3) Offset of permanent total disability benefits must be made by a paying agent only in an amount and as authorized by the director. (4) Offset of permanent total disability benefits will be authorized by the director only upon actual receipt of federal social security disability benefits by the injured worker. Stat. Auth.: ORS 656.209 & 656.727 Stats. Implemented: ORS 656.209 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0100, 5-1-85; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16436-100-0020 Requirements of Workers (1) Workers entitled to receive permanent total disability benefits must make application for federal social security disability benefits. (2) Workers and eligible beneficiaries must, upon department request, execute a release form authorizing the Social Security Administration to make disclosure to the department of such information regarding the injured workers as will enable the department to carry out the provisions of ORS 656.209 and these rules. (3) Whenever there is a change in the federal social security beneficiary eligibility, the worker must notify the Performance Section. (4) Upon request of the department, the worker may be required at any time to furnish additional information regarding social security disability benefits. Stat. Auth.: ORS 656.209 & 656.727 Stats. Implemented: ORS 656.209 & 656.727 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0115, 5-1-85; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16436-100-0030 Authorization of Offset; Effective Date (1) Authorization issued by the department will be directed to the paying agent with a copy to the injured worker. (2) A paying agent making payment of permanent total disability benefits will be entitled to social security disability offset only as authorized by the department. (3) The department will review the social security offset calculation when notified of a change in the status of a worker subject to social security offset. An amended authorization will be issued, if necessary. (4) Whenever there is a change in eligibility status of the worker or any one of the worker’s beneficiaries receiving benefits for permanent total disability subject to offset, the paying agent must notify the Performance Section. (5) The paying agent must, immediately upon the death of a worker, terminate payment of previously authorized permanent total disability benefits offset and begin payment of other compensation due under ORS Chapter 656, if any. (6) The effective date of offset must be the effective date established in the authorization. Stat. Auth.: ORS 656.209 & 656.727 Stats. Implemented: ORS 656.209 & 656.727 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0130, 5-1-85; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16436-100-0040 Sanctions Against Worker for Failure to Cooperate with the Department (1) Any worker entitled to receive permanent total disability benefits who fails to comply with these rules will be subject to suspension of benefits until the worker has complied. (2) If a worker fails to comply with these rules, the director will make a written demand upon the worker by personal service or registered mail. If the worker fails to comply within 20 days of receipt of the demand, the director may authorize suspension of benefits until the worker complies. (3) An order of suspension of benefits will continue in force from the date issued until the date the worker actually complies with these rules. (4) No compensation will become due or be payable during a period of suspension of benefits. Stat. Auth.: ORS 656.209 & 656.727 Stats. Implemented: ORS 656.209 & 656.727 Hist.: WCB 7-1978, f. 6-5-78, ef. 6-6-78; WCD 4-1983(Admin)(Temp), f. & ef. 9-1-83; WCD 2-1984(Admin), f. & ef. 2-22-84; Renumbered from 436-057-0150, 5-1-85; WCD 7-2015, f. 10-12-15, cert. ef. 1-1-16

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